Gluten free diets are a hot topic and apparently they're not just for Celica's

There was a lot of ground to cover in this month’s myth bust, so it will be coming to you in a two part instalment. Part 1 clears up some background information about what gluten is and why people might avoid it for medical reasons while Part 2 looks at those other reasons people are avoiding gluten, like for weight loss and general health - enjoy

We know that for people medically diagnosed with Celiac Disease a strict gluten free diet is necessary to prevent damage to the villi which line the small intestine wall. Along with gastrointestinal distress, the damage caused to the villi by Celiac Disease can lead to malabsorption, nutrient deficiencies and secondary conditions such as osteoporosis. But, for the other 99% of the population (yep, only about 1% of people are Celiac) is there any reason to jump aboard the gluten free movement? (1)Food fashions and fads come and go and it seems at the moment ‘going gluten free’ is in style. Celebrities are doing it, all the trendiest restaurants and cafes feature gluten free options, it’s a hot topic in the media, and a multimillion dollar industry (which far exceeds the needs of Celica’s), has emerged almost overnight.

What is Gluten?

There seems to be a huge amount of confusion around what gluten actually is and consequently the myths about why people should avoid it. So let’s clear that up to start with.Gluten is a protein found in wheat, rye, barley, triticale and oats (controversially) but its uses within the food supply spreads far and wide as along with being found in products that use these grains it acts as a great thickening agent in many sauces, condiments and processed meats. Clearly avoiding all of these foods in order to ‘go gluten free’ is quiet a commitment and requires an extensive diet overhaul.Fortunately, there are many foods that are naturally gluten free that can be appropriately substituted into the diet, including amaranth, arrowroot, buckwheat, cornflour and meal, millet meal, polenta, psyllium, quinoa, rice, sago, sorghum and tapioca. Of course many specifically developed gluten free products are available too.So in the absence of Celiac disease, why are people going gluten free?

'Gluten Allergy'

More than likely you may have come across someone with a “gluten allergy,” this however is a complete myth – or at least a bit of a misunderstanding on what may actually be a wheat allergy, Celiac Disease, gluten sensitivity, or another gluten related aetiology.A wheat allergy is an immune mediated reaction to wheat itself and there is no question it is legit (estimated to affect 0.1% of the population); Celiac disease is an autoimmune disease, which like many autoimmune diseases, presents with mixes aetiology (over 300 symptoms have been reported!), it has an accepted diagnostic protocol and common clinical markers; Gluten sensitivity or intolerance however, is a bit of a phantom condition that is still under a lot of investigation. (2)

Gluten Sensitivity

In the absence of Celiac Disease or a wheat allergy there is a sub-population who report being gluten sensitive or intolerant (often referred to as non-celiac gluten sensitivity; NCGS). Unlike Celiac Disease or wheat allergies, NCGS is far less understood which makes diagnosis and even recognition of the condition difficult, however it has very crudely been estimated that 20% of the population believe they are gluten sensitive or intolerant – many of them self-diagnosed (rightly or wrongly). (3)

NCGS as a condition has only really been validated in the last few years, it often comes with similar symptoms as Celiac Disease (abdominal pain, diarrhoea, bloating and excessive wind, as well as lethargy, poor concentration and general aches and pains), however does not result in the same villi damage as Celiac Disease and as yet has no accepted clinical markers. Much research (with much funding from the gluten free food industry), has been done into this condition in an effort to uncover and legitimise it, too little prevail. (3,5) It is largely thought that NCGS generally occurs from a heightened immunological response to gluten in genetically susceptible people, although this isn’t universally accepted (6). Regardless of this, for people with this phantom condition removing gluten from their diet seems to alleviate the symptoms.Interestingly however, recent research has suggested that in the case of NCGS, gluten may not be the culprit at all. A double blinded cross over trial of 37 patients with NCGS were placed on a low FODMAP diet (fermentable, oligo-, di-, monosaccharides, and polyols; Short chain carbohydrates which are hard to digest, leading to fermentation in the gut hence boating, wind and discomfort), for 2 weeks then placed on either a high-gluten (16 g gluten/d), low-gluten (2 g gluten/d and 14 g whey protein/d), or control (16 g whey protein/d) diets for 1 week, followed by a washout period for 2 weeks. Several months later twenty-two of the participants then crossed over to another protocol group for a further 3 days. The researchers found that all participants’ symptoms improved on the low FODMAP diet and only 8% of participants had gluten specific responses. (4) This is only one small study and obviously a lot more research is needed but the results suggest that people who are “gluten sensitive” may feel improvements in gastrointestinal problems consequently as a gluten free diet is also low in FODMAPs. This study again raises questions of the legitimacy of NCGS and questions the appropriateness of treatment with a gluten free diet. FODMAPs are found in many foods, including fruits and vegetables and can affect people differently, so simply removing foods which contain gluten may not be appropriate. (For this reason it is important not to self-diagnose or simply choose gluten free without seeking medical advice.)Similarly, another recent review suggested that other constitutes of grains, particularly wheat, may be the underlying issue in NCGS and not in fact gluten. (5)

Gluten Free for other conditions

Further to this, gluten free diets have been used for the treatment/management of schizophrenia, multiple sclerosis, dementia and a bunch of other diseases, but unfortunately the actual benefits of this treatment/management protocol remains ‘alleged’ with insufficient evidence to support a medical benefit from a gluten free diet in these conditions. (6, 9) Regrettable, autism one of the many ‘other’ conditions to have insufficient evidence to support any benefit of a gluten free diet. (7, 8) Fortunately though, no harm has been reported either.The conditions mentioned are highly complex with multiple aetiology and comorbidities, much is still unknown about them and despite current limitations in evidence much support remains for trialling a medically supervised elimination diets. (9)

Why else avoid Gluten?

Beyond these conditions gluten has been branded as the cause of weight gain, general feelings of lethargy, poor health, and inflammation which is said to underpin heart disease, diabetes, cancer, and arthritis, amongst other things. Consequently, the hyped reasoning to avoid gluten includes increased energy levels, aiding weight loss, and a general “healthy” or “lighter” option.With this impressive health resume, does a gluten free diet live up to the hype - Should we all be avoiding gluten? – Stay tuned for part 2 of this monthly myth bust.

T’is the season to be jolly – so why have my kids been so irritable and restless?One minute they are bouncing off the walls, the next they’re in a heap screaming on the floor. They don’t listen, they can’t concentrate and all they seem to do is fight with each other…Could the copious amounts of sugar laden festive treats be to blame for their hyperactivity? The idea that sugar causes hyperactivity in kids has been around for a long time and is fairly well accepted within certain circles, but the truth of the matter is, this is a complete myth – Sugar does not cause hyperactivity in children.

What is hyperactivity?

Clinically, hyperactive (as one diagnostic component of ADHD), is generally diagnosed after a rigorous testing process, based on multiple and ongoing symptoms such as fidgeting or tapping of hands or feet, squirming when seated, leaving a seat in situations when remaining seated is expected, running about or climbing in situations where it is not appropriate, an inability to play or take part in leisure activities quietly, often "on the go" and acting as if "driven by a motor",talking excessively, blurting out answers before a question has been completed, trouble waiting their turn, or interrupting or intruding on others (e.g., butts into conversations or games).(1)So despite how the term is often used, hyperactivity is not an intermitted bout of excited, energetic or reckless behaviour caused by a cup of cordial at a birthday party.

How did it all start?

The notion that sugar causes hyperactivity seems to have emerged around the time of the Feingold Diet, which was developed by an allergist in 1973 who advocated a diet free of salicylates (naturally occurring compound found in many foods), food colourings and artificial flavours to treat hyperactivity. (2)Since then, the idea of sugar causing hyperactivity in children has been a hot research topic and ruthlessly studied. A review of twelve double-blinded, placebo-controlled trials into this issue however concluded that sugar did not cause hyperactivity in children with or without ADHD. (3) Similarly, a meta-analysis of 16 studies also concluded that sugar did not affect a child’s behaviour or cognitive performance. (4)Although both of these studies were conducted in the mid 90’s and are somewhat dated, a more recent systematic review conducted between 1995 and 2006 showed similar results, concluding there was no credible evidence linking sugar to ADHD (or dementia or depression). (5)

It's all in your head

So why do kids turn feral at birthday parties? – because pass the parcel is the true cause of hyperactivity… Ok maybe not, but research has suggested that it’s all a matter of perception. Basically, a research team lied to a bunch of mums who believed their 5-7 year old boys were “sugar sensitive.” All children were given a placebo drink (no sugar) but half the mothers were told their child had been dosed with sugar. The mothers who believed their children had been given sugar rated the child’s behaviour worse and, interestingly, were also noted to be more controlling and critical of their child. (6)

If not sugar then what?

Of course many highly processed foods which happen to be laden with sugar also contain artificial colours, additives and preservatives, which in a small number of sensitive children can trigger behavioural problems like irritability, restlessness and mood swings along with headaches, skin irritations, and digestive distress amongst other things. (7) So in the case of these reactions, sugar could be masking a sensitivity to additives, preservatives or colourings – just as Feingold had suggested back in 1973. Remember however, that such sensitivities or intolerances are not necessarily restricted to artificial food stuffs but also can occur from many naturally occurring compounds like salicylates, amines and glutamates found naturally in fruits, vegetables, nuts, seeds, meat, dairy.

So why have my kids been so restless and irritable over the school holidays?

Well probably because they are spoilt little sods… =)Realistically, children are highly excitable, emotionally immature, overwhelmed easily, and quiet often in need of a good sleep. These traits partnered with a big bowl of sugar at breakfast, lunch and/or dinner (typically disguised in the form of breakfast cereal, juice, biscuits, muesli bars and other crap marketed to kids) typically results in tantrums, poor concentration and irritability simply as a result of the blood sugar “crash” that comes with these high GI foods – you can also imagine that for a child diagnosed with ADHD, who already may suffer these symptoms, a sugar “crash” could quiet dramatically exacerbate these symptoms. The simple solution: choose less processed foods which apart from often being high in sugar and salt, are often high GI and contain little fibre so don't provide stable or sustained energy; choose more wholefoods including fruits, vegetables, nuts, seeds, legumes and whole grains which are higher in fibre; enjoy all foods in moderation; and, accept that your child is a little monster =)So sugar might not cause hyperactivity, but is it toxic?

*If you suspect your child has a food sensitivity, intolerance or allergy seek professional help from a registered dietician who is able to guide you through an appropriate elimination diet whilst maintaining nutritional adequacy. Similarly if you suspect your child is hyperactive seek appropriate medical advice.